SMGr up
SM Journal of
Psychiatry &
Mental Health
Article Information
Received date: Aug 21, 2017
Accepted date: Oct 14, 2017
Published date: Oct 23, 2017
*Corresponding author
Tania Gaspar, Rua da Junqueira nº
188-198 1349-001, Portugal, without chronic illness in a biopsychosocial perspective.
Tel: + 351 21 3611500 /
+ 351 96 285 2290; (purpose of life and stress management skills) and by social factors (social support satisfaction and relationships
Email: tania.gaspar.barra@gmail.com
Distributed under Creative Commons
CC-BY 4.0
Keywords Psychosocial factors;
Diabetes; Arterial hypertension;
Subjective wellbeing
OPEN ACCESS
ISSN: 2576-5477
Research Article
Psychological and Social Factors that
Influence Quality of Life in Aging People
with and without Chronic Diseases
Tania Gaspar1,2* and Manuel Domingos1,3
1
Department of Psychology, Lusiada University, Portugal
2
ISAMB/Medical Faculty/University of Lisbon, Aventura Social, Portugal
3
Department of Neuropsychology, Portugal
Abstract
Objective: Quality of life is influenced by psychological and social factors. Our main objective is to better
understand and characterize the impact of social and psychological characteristic in quality of life in aging
population with and without diabetes and other chronic disease.
Method: The data was collected at the national level. The sample is composed of 1,330 people 62.2% of
which were female, with ages ranging between 55 and 75 years old. 48.2% of the sample mention having a
chronic condition, 34.4% of which had diabetes.
Three regression models were created in order to understand the quality of life in aging population with and
Results: Results showed that quality of life in aging population is influenced by psychological factors
with supervisor at work). Having a chronic disease, such as diabetes, can also influence quality of life.
Conclusions: Our study allowed us to conclude that quality of life is influenced by physical health,
psychological health and social health. The psychological factors presented a more systematic and strong
influence in quality of life in population with and without chronic disease.
Purpose
The positive and healthy psychosocial development is influenced by individual and ecological
factors [1,2]. The biopsychosocial model is a broader and integrative approach to human behavior
and disease. This model provides a conceptual frame work for dealing with disparate information
and serves as a reminder that human behavior is influenced by biological, psychological and social
factors. This model is the exact application of World Health Organization (WHO) definition of
health [3]. Now there is general acceptance that psychological, behavioral and social factors interact
with pathological process in the development and evolution of physical disorders and that these
factors substantially influence consultation and compliance with treatment.
The biological system is related to anatomical, structural and molecular subtract of disease and
the effects on the patient’s biological functioning. Psychological system deals with effects of emotions
and personal characteristics, such as motivation, self-regulation, purpose of life and personality on
the experience of and the reaction to illness. Social system exams the cultural, environmental, family
and peer group influences on the expression and experience of illness. This model shows health as
being determinate and influenced by biological, psychological and social factors and shows illness
has been a consequence of the interplay of these factors [4,5].
The biopsychosocial approach is able to extend health care beyond the patient to include the
family and community and emphasizeson one hand, the prevention of illness and promotion of
health, and on other hand, the treatment of disease. Behavioral and emotional aspects should be
taken into consideration when treatment decisions are made. This approach is related to stress
management, self-regulation, emotions, person’s attitudes, beliefs, values and behaviors [5].
Psychological intervention can be integrated into routine usual care to assist people to make the
recommended lifestyle changes. This intervention should include assessment and a personalized
program in which realistic, manageable goals for lifestyle change and overcoming barriers
are negotiated using brief motivational interviewing. It was observed that health psychology
interventions are effective in the prevention and treatment of lifestyle-related chronic diseases [6,7].
Social support plays an important role in disease management. The direct social support is
associated with long-term health among middle-aged and older adults with diabetes. Interventions
that specifically target improving specific aspects of diabetes social support may be more effective in
improving long-term health than less targeted efforts [8].
How to cite this article Gaspar T and Domingos M. Psychological and Social Factors that Influence
Quality of Life in Aging People with and without Chronic Diseases. SM J Psychiatry Ment Health.
2017; 2(2): 1011.
SMGr up
For example, diabetes and other related diseases are chronic
conditions which, if left untreated, can cause serious health and
economic consequences. The biological model has been successful
in describing the disease and identifying treatments. However,
while the effectiveness of disease treatment has been proven in a
number of studies, adherence to treatment is extremely low. The
biopsychological model may contribute to the understanding and to
the increase in treatment adherence in chronic diseases. Adherence
is influenced by behavioral factors, it is important that patients and
caregivers recognize relevant psychological and sociological factors
[9-13].
Quality of life and health status
The Quality of Life (QoL) is a multidimensional construct that
involves physical, psychological and social dimensions. In the study
developed by Gaspar and Torres health variables were analyzed
(participants were asked about whether they have diseases that
affect the day-to-day, medication and health perception), personal
variables were also measured, namely, purpose of life, spirituality
and cognitive style and finally were evaluated social variables, such as
social support and psychosocial work factors. The socio-demographic
information related to age, gender, region of the country, family
status, and employment status among others was also measured and
studied. Through the study results can be concluded that participants
who had a better quality of life were the ones presented (a) factors
related to more positive health; (b) psychological factors, a sense of
more positive life and spirituality especially related to more positive
optimism; (c) greater satisfaction with social support; and (d) mostly
had higher education, were married, lived in own home, had no
chronic disease and were retired with professional activity. Those
relationships were conditioned by individual factors, such as age,
gender, health status and employment status.
Diabetes is one of the most common chronic disease and a global
health problem. The number of people with diabetes and other chronic
and behavioral diseases is increasing due to population growth, aging,
urbanization and the increase of obesity, physical inactivity and other
unhealthy behaviourshttp://www.idf.org/diabetesatlas/.
The most important demographic change to diabetes prevalence
appears to be the increase in the proportion of people with more than
65 years old [14].
There has been an increase in the number of old people with
diabetes, and older people have, in general, an increased rate of
diabetes-related complications, and are much more likely to present
comorbid conditions. These include physical disability, cognitive
dysfunction, fall and fractures, depression, pressure ulcers, impaired
vision and hearing and under-treated pain [15]. Diabetes with the
natural aging process and other age-related conditions, contribute
to poorer outcomes in older people with diabetes when compared to
old people without diabetes, for instance, people with diabetes are 1.5
times more likely to develop dementia than those without diabetes.
Several studies show a strong association between diabetes and
depression, which can affect the people’s ability to seek treatment and
to care for themselves [16].
Complications related to diabetes are the major causes of
mortality, disability and reduced quality of life. People with diabetes
have a two-fold increased risk of death compared with people without
Citation: Gaspar T and Domingos M. Psychological and Social Factors that Influence Quality
of Life in Aging People with and without Chronic Diseases. SM J Psychiatry Ment Health.
2017; 2(2): 1011.
Copyright  Gaspar T
diabetes. Cardiovascular disease is the leading cause of death in
people with diabetes [17].
Diabetic and other chronic disease patients have a statistically
significant lower HRQoL in several domains, such as physical health,
psychological and social relationship [18-20].
The evaluation of the quality of life was regarded as positive in
most of the measured dimensions. The social relationships have the
biggest score in all the domains, which mean that it contributed the
most to a good quality of life [21,22].
The results from the application of the WHOQOL-BREF suggest
that the patients with type 2 diabetes have a low quality of life. Some
factors that influence these results are the education levels, marital
status and household income. Diabetic man have a better quality of
life than diabetic women, and also, younger people have significantly
higher quality of life, than older people [21,23]. Both physical and
psychological domains are significantly lower for the diabetic group,
and present stronger effects on the physical than the psychological
domain. Another factor, the education level, shows that patients with
lower education also have lower quality of life and are more affected
by both physical and psychological domains, than those with higher
education [21,24].
A growing awareness related to the importance of psychological
and social influences on health and illness have led to the development
of a biopsychosocial framework for research and intervention. This
integrative model can serve as a basic framework for academic and
clinical research in many areas, including assessment of patients’
health-related quality of life (HRQoL), and can take into account the
inseparable nature of physical, psychological and social factors.
Our main objective is to better understand and characterize the
impact of social and psychological characteristic in quality of life in
aging population with and without diabetes and other chronic disease.
Method
Participants
The sample consisted of 1,330 participants’ with ages between 55
to 75 years old, which average age was about 60 years. With regard
to gender, 62% were female and 38 % male. 48.2% of the sample
mention having a chronic condition 34.4% of which had diabetes.
Of the respondents, 47% maintained an occupation and 46 % were
retired.
Related to educational level, 40.8% had until compulsory
schooling (4 to 12 years) and 36.2% presented higher education.
Instruments
The instrument was composed by some socio demographic
related questions and by questionnaires related to quality of life,
social support, purpose of life and psychosocial factors at work.
Quality of life (WHOQOL-BREF)
The Instrument name is WHOQOL-BREF (World Health
Organization Quality of Life - Brief), the authors and date of
the original version is WHOQOL Group, 1994 (World Health
Organization Quality of Life Group), in this study was used the
Portuguese version [25]. It is a generic, multidimensional and
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multicultural measure to assessment subjective quality of life and can
be used in a wide range of psychological and physical disorders, as
well as healthy individuals. It consists of 26 items and includes four
domains of quality of life: Physical, Psychological, Social Affairs and
Environment. Each of these domains consists of facets of quality of
life that summarize the particular domain of quality of life to which
they belong. This measure also allows the calculation of a global
indicator, in particular facet of the overall quality of life.
Internal consistency, measured by Cronbach’s alpha shows
acceptable values, whether analyzing the four domains (0.90) or
each individual domain [ranging from 0.86 (Spirituality) and 0.95
(Psychological).
Psychosocial factors of labour (COPSOQ)
The instrument that measured psychosocial factors at work
(COPSOQ II) was developed and validated by [26] in collaboration
with the Danish National Institute of Occupational Health in
Copenhagen. The main objective is to evaluate the psychosocial
factors at work. The internal consistency (Cronbach’s alpha) sub
scales of COPSOQ is between 0.60 and 0.90 (with the exception of
2 subscales).
The COPSOQ II follows a multidimensional concept and is
intended to cover the general needs involved in the scope of the
concept of “stress at work”. It is based on demand model and control,
trying to explain the psychosocial risk factors at work as a result of
high job demands and low social support. The short version includes
the psychosocial dimensions with epidemiological evidence related to
health. All versions evaluate exposure indicators (psychosocial risks)
and indicators of its effect (health, satisfaction and stress). All items
of the three versions are assessed on a Likert scale of 5 points: 1 -
never / hardly ever; 2- Rarely; 3- Sometimes; 4 - Often; 5- Always;
or 1 - Nothing / almost nothing; 2. A little; 3- Moderately; 4-Very;
5 - Extremely.
In the present study, when this instrument was applied to
participants who were retired, they were asked to report to the time
they had a professional activity.
Satisfaction scale with social support (Ribeiro - ESSS)
The instrument name is Satisfaction Scale with Social Support
(ESSS) was developed and validated by [27]. The ESSS was built to
measure satisfaction with the existing social support. The internal
consistency (Cronbach’s alpha) of the total scale is 0.85. This
instrument consists of 15 sentences of self-completion as a set of
statements. The subject indicates the degree to which you agree
/ disagree with the statement, in a Likert scale with 5 positions:
“strongly agree”, “agree mostly”, “neither agree nor disagree”,
“disagree mostly” and “strongly disagree”.
The ESSS can extract four dimensions or factors: Satisfaction
with Friends / Acquaintances (SA); Intimacy (IN); Satisfaction with
Family (SF) and Social Activities (AS). The scale also allows to obtain
a global score (ESSS), representing the highest marks to a perception
of greater satisfaction with social support.
Purpose of Life (PIL) - Part A (or Purpose of Life Test - Pil-
Test)
The instrument related to life goals (PIL) was developed and
Citation: Gaspar T and Domingos M. Psychological and Social Factors that Influence Quality
of Life in Aging People with and without Chronic Diseases. SM J Psychiatry Ment Health.
2017; 2(2): 1011.
Copyright  Gaspar T
validated by [28] and reviewed by [29], constituting the Pil-R version.
The instrument assesses the construct sense of life in their ranks:
the degree of existential emptiness and the level of achievement of
meaning in life. The internal consistency (Cronbach’s alpha) of the
test is 0.88.In keeping with the Portuguese population of advanced
adulthood. This instrument consists of a Likert scale composed of
20 items, which aims to fundamentally assess the level of existential
emptiness and willing to live sense in an evaluation 7-point scale: 1
- strongly disagree; 2 - Disagree largely; 3 - Somewhat disagree; 4 -
Neither Agree Nor Disagree: 5 - Somewhat agree; 6 - I agree for the
most part; 7 - Totally agree. Items in this scale include the following
aspects: purpose in life, satisfaction with life, freedom, fear of death,
suicidal ideation and if life is worth.
Procedure
Initially the Psychosocial Factors of Work (COPSOQ) suffered a
process of translation and back translation involving two Portuguese
researchers and bilingual researcher (Portuguese / English).
All demographic issues and assessment tools had been integrated
in the form of a battery; this battery was tested in a group of 20
people between 55 and 75 with different socio-economic and cultural
characteristics in order to assess suitability.
The final version included some changes in demographics, in
order of presentation of the instruments and was removed the scale
of violence in the work from the work Psychosocial Factors scale
(COPSOQ).
Were contacted several organizations, such as unions, businesses,
municipalities, day care centres, senior universities, NGOs working
with people within the age range of the study, and others to
collaborate on data collection. Data collection was carried out with the
institutions that agreed to cooperate and with people who agreed to
complete the questionnaire. The questionnaire was self-completion,
anonymous and confidential.
Results
Statistical differences were found between participants with
and without diabetes and other chronic diseases. Participants with
chronic diseases present less healthy indicators than the participants
without chronic diseases. Participants with chronic diseases present
low values in quality of life, social support satisfaction, purpose of life
and stress management at work (Table 1).
Regression models were developed, in order to better understand
the impact of having chronic diseases in quality of life in aging
population and the meditative effect of psychological and social
factors in quality of life in aging people with chronic diseases. These
models (Table 2) used quality of life as a dependent variable.
Were built three models using the demographic variables, the
psychological and social variables, and were achieved robust models.
The Regression Model 1 in table 2 included gender, age and health
condition and an adequate model was achieved [F=42,276 (3,785);
p<.001] and the explained variance (Adjusted R squared) was 14%.
In regression model 2, besides demographic and health condition
variables were included social variables, such as, social support
and relations with supervisors at work and an adequate model was
achieved [F=46,123 (5,783); p<.001] and the explained variance
(Adjusted R squared) was 23%.
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Table 1: ANOVA - Quality of Life, Chronic Diseases Status, Psychological and Social Characteristics.

People with Chronic Disease (CD)

Participants without CD Participants with CD

Dimensions F
M SD M SD

Quality of Life 3.9 0.55 3.3 0.77 210.74***

Social Factors

Social Support 3.57 0.54 3.39 0.61 28.16***

Relation with supervisors at work 3.58 0.77 3.51 0.78 (n.s.)

Psychological factors

Purpose of Life 5.3 0.66 4.97 0.82 47.05***

Stress management at work 3.3 0.69 2.88 0.73 94.42***

***
p <.001; **p <. 01

Table 2: Impact of demographic, psychological and social characteristics in quality of life in people with and without chronic diseases - Regression models - dependent
variable quality of life.

Unstandardized Coefficients Standardized Coefficients

Model t
B Std. Error Beta

(Constant) 4.65 0.19 24.783

Age -0.01 0.03 -0.07 (n.s.) -2.112

1
Gender 0.06 0.05 0.04 (n.s.) 1.308

chronic diseases -0.49 0.05 -0.35 ***

-10.49

(Constant) 3.27 0.23 14.264

Age -0.01 0.03 -0.08** -2.49

Gender 0.04 0.04 0.03 (n.s.) 0.853

2
chronic diseases -0.43 0.05 -0.31*** -9.593

Social Support 0.3 0.04 0.26 ***

7.803

Relation with supervisors at work 0.09 0.03 0.10*** 3.051

(Constant) 2.05 0.24 8.457

Age -0.03 0.03 -0.04 (n.s.) -1.289

Gender -0.03 0.04 -0.03 (n.s.) -.845

chronic diseases -0.32 0.04 -0.23*** -7.706

3
Social Support 0.06 0.04 0.05 (n.s.) 1.515

Relation with supervisors at work 0.03 0.03 0.04 (n.s.) 1.179

Purpose of Life 0.23 0.03 0.25 ***

6.98

Stress management at work 0.26 0.03 0.28*** 8.321

Dependent variable Quality of Life.

***
p <.001; ** p<.01;* p < .05
Finally, in regression model 3, besides demographic and health
condition variables, and social variables were included psychological
variables, such as, purpose of life and stress management at work.
Model3e resulted in an adequate model [F=63,023 (7,781); p<.001]
and the explained variance (Adjusted R squared) was 36%.
Discussion and Conclusions
Our results show that quality of life is influenced by psychological
and social factors and health conditions should be understanding in a
biopsychosocial perspective. This perspective includes the biological
aspects that can effects the patient’s biological functioning, includes
the psychological system related to emotions and personal and
includes also the social system associated to cultural, environmental
and family/friends influences on the expression and experience of
illness. This model shows health has been determinate and influenced
by biological, psychological and social factors and, shows also, that
illness is a consequence of the interplay of these factors [4,5].
Most of the participants reported good quality of life [30] obtained
similar results in their study. Chronic health condition is associated
with quality of life. Diabetic and other chronic disease patients have
a statistically significant lower HRQoL in several domains, such
as physical health, psychological and social relationship. On this
perspective, social support satisfaction with family and friends is
related to quality of life, and psychological factors, such as purpose of

Citation: Gaspar T and Domingos M. Psychological and Social Factors that Influence Quality
of Life in Aging People with and without Chronic Diseases. SM J Psychiatry Ment Health.
2017; 2(2): 1011. Page 4/6
SMGr up
life and stress management skills are also related to quality of life in
aging population [18-21]. Age and gender do not presented relevant
influence in quality of life, those results are different from the studies
developed by Gaspar & Torres and Gholami [21,23].
A model to understand the factors that influence quality of
life, that just included health condition and psychological variables
showed to be a most robust model. The psychological variables
present the strongest impact in quality of life [31,32,16]. Psychological
intervention can be integrated into routine usual care to assist people
to make the recommended lifestyle changes. Include psychological
factors in interventions is effective in the prevention and treatment of
lifestyle-related chronic diseases [33,7].
The resultant models reported in Table 2 presented a
biopsychosocial perspective, and showed robust results to aging
population in general and showed be a good model to understand
quality of life in aging population with health chronic conditions,
mostly diabetes and related diseases [18-20,22,34,35].
Achieved models showed that social and psychological
characteristics present a stronger explicative value on aging population
quality of life. Therefore, we conclude that especially psychological,
but also social factors can be considered protective factors related
to aging population with and without chronic health diseases. The
prevention and intervention with aging population should include
the promotion of social and psychological skills in aging population,
family and the community.
Promoting good health and healthy behaviors at all ages
contribute to prevent or delay the development of chronic disease.
If the chronic disease already exit is important minimizing the
consequences through early detection, quality care and psychosocial
skills promotion. The intervention in health promotion in aging
population should create physical and social environments that
foster the health and participation of older people and is important
changing personal and social attitudes to encourage the participation
of older people [36].
Monitoring quality of life in aging population with and without
chronic disease is particularly important, despite the variety of
medical, social and psychosocial interventions they may have had.
A psychologist, other social or health professionals who measure the
quality of life can promote a better multidimensional welfare in these
aging population in terms of family, community and other areas that
reflect risk or protective factors in relation to their aging process.
The assessment of quality of life may be useful in screening and
identifying individuals who are at risk of developing behavior or
health complications, which is crucial for social programs, health
promotion and prevention programs.
The relationship between quality of life, health status,
psychological factors and social factors, and the protective impact
that personal and social factors can have in aging population health,
are important indicators and provide a strong argument for scientific
research in quality of life in aging population using an biopsychosocial
perspective by psychologists, other social/health professionals and
community contexts who have to confront the challenge of providing
services that are sensitive to cultural and individual differences
[36,37].
Citation: Gaspar T and Domingos M. Psychological and Social Factors that Influence Quality
of Life in Aging People with and without Chronic Diseases. SM J Psychiatry Ment Health.
2017; 2(2): 1011.
Copyright  Gaspar T
The study presented some limitations, one of them is the
representativeness, the participants are Portuguese and was used a
convenience sample, so the results cannot be representative for aging
population. Could be interesting study specific chronic diseases
and comorbidity among diseases including mental health problems
related to dementia, depression and anxiety.
Despite of study limitations, our conclusions and proposed
models can be considered contributions to better understand and
to promote a more effective intervention related to quality of live
in aging population with and without chronic health situations,
using a biopsychosocial approach and reinforce the relevance of
psychological factors.
Practical implications
Our results suggest strongly that, the existence of chronic health
conditions in aging population can impair their quality of live or
at least increase their vulnerability, but the most important feature
is that this situation is really impacted by the strength of personal
and social factors that can have a buffering effect. The intervention
consequences of this impact are huge and call for a change in the
organization of support services, both, health and social services,
for aging people with and without chronic health situations that
must include a positive focus: the promotion of personal and
social competences and the promotion of a social support network,
including family and community.
Having chronic health conditions can be considered a risk factor
related to quality of live in aging population. The impact of this risk
or the health complications and psychological consequences can be
reduced if aging people develop social and psychological skills to face
the risk and improve positive aging opportunities.
Ethical approval: The study involved human so all procedures
performed in studies involving human participants were in accordance
with the ethical standards of the institutional and national research
committee (Regional Administration of Portuguese Health Ministry)
and with the 1964 Helsinki declaration and its later amendments or
comparable ethical standards.
Informed consent was obtained from all individual participants
included in the study.
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